The inspection took place on 10 and 11 May 2017 and was unannounced on the first day. Merafield View Nursing Home (Merafield) provides care for people who may require nursing care and for people who are living with dementia. Merafield provides care and accommodation for up to 40 people. On the day of the inspection 38 people lived in the home.

A registered manager was employed to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There was a very positive culture within the service. The registered manager had clear values about how they wished the service to be provided and these values were shared by the whole staff team. Staff talked about ‘personalised care’ and ‘respecting people’s choices’ and had a clear aim about improving people’s lives and enabling opportunities where possible.

There was a management structure in the service which provided clear lines of responsibility and accountability. The registered manager was highly valued and well respected by people, relatives, staff and local professionals.. They were supported by an extremely knowledgeable, caring team of nurses and support staff who had designated management responsibilities. All areas of the home were exceptionally well managed including housekeeping and the kitchen. People told us they knew who to speak to in the office and any changes or concerns were dealt with swiftly and efficiently.

Staff were exceptionally thoughtful and kind. Their care and love for people at Merafield made them feel they mattered and staff and relatives gave many examples of going the extra mile to make someone feel special. Feedback we received about staff was superb.

End of life care was excellent. People’s last days were dignified, pain free and relatives were fully involved and supported at all stages.

Feedback received by the service and staff was exceptional. Outcomes of audits and incidents were used to aid learning and drive improvement across the service. Robust action plans drove further improvement. Training and networking by staff across the city improved the care and outcomes for people. The manager and staff monitored the quality of the service by regularly speaking with people to ensure they were happy with the service they received. People and their relatives told us the management team were excellent, visible and included them in discussions about their care and the running of the service.

The service had strong links with organisations in the local community including the local hospital, acute hospital and the local authority. The registered manager was well respected across these organisations and the service was involved in pilots with Plymouth University to trail technology within nursing homes and a pilot project to reduce falls.

People loved the homecooked food and lovely smells which came from the kitchen. Mealtimes were a positive experience, which people looked forward to. Meals were of sufficient quality and quantity and there were always alternatives on offer for people to choose from. People were involved in planning the menus and their feedback on the food was sought. Allergies and preferences were known. People at risk of poor hydration or nutrition were monitored closely and cared for well. This could move down as its from a good rated domain.

People told us they felt safe using the service. There were risk assessments in place to help reduce any risks related to people’s care and support needs. Staff had received training in how to recognise and report abuse and were confident any allegations would be taken seriously and investigated to help ensure people were protected.

People were kept safe by suitable staffing levels. Relatives told us there were enough staff on duty and we observed unhurried interactions between people and staff. This me